A Case of Accidental Autoerotic Death by Hanging Linked to Erotic Photography.

Autoerotic death, as a subtype of mechanical asphyxia, refers to a person's fatal outcome while engaging in solitary sexual activity using various devices and methods to reduce oxygen supply and induce cerebral hypoxia, leading to increased sexual gratification. These asphyxial deaths are accidental and sporadic. In cases of sexual asphyxia, especially when strangulation methods such as hanging or ligature are used, thorough crime scene investigation is crucial to determine the type of asphyxia and the manner of death. Inadequate information about specific crime scene findings can lead to significant errors in determining the manner of death and the type of strangulation, potentially leading to cases being mistaken for ligature strangulation in a homicidal manner or hanging in a suicidal manner.

The need for mandatory autopsy teaching in Forensic Medicine for medical students.

The effectiveness of the autopsy as an educational tool in forensic medicine courses has been widely acknowledged, and medical students were expected to attend regularly. Nevertheless, the use of autopsies for teaching has dramatically declined in recent years and worldwide despite their high-value benefits. This study aims to understand the importance and relevance of attending autopsies during forensic teaching sessions and identify any challenges that may impede attendance. A self-administered online questionnaire that assesses the knowledge, attitudes, and practices related to autopsies attendance was distributed to fourth-year medical students at the National Defence University of Malaysia and Universiti Sains Islam Malaysia. A total of 99 respondents were involved in this study. Our findings indicate that most respondents (over 85%) demonstrated good knowledge of forensic medicine. Pearson's statistical test revealed a significant correlation between the knowledge and students' attitudes toward autopsy. This study demonstrates the need to strategically integrate autopsy attendance into medical curricula to encourage constructive attitudes and practices among medical students. Students gain the most benefits from frequently attending autopsies. Passionate educators can conduct preparatory sessions to set expectations and address concerns, encourage students to process their experiences, and reinforce learning outcomes in the mortuary setting. Mandatory autopsy teaching should be integrated into the curriculum to ensure medical students have the necessary skills and knowledge to become competent doctors.

Gender determination using mandibular intercanine distance and mesiodistal width of right mandibular molar.

Background: Forensic odontology plays an important role in mass disasters, house fires, criminal deaths, identification of missing persons, and child abuse cases. Teeth are the most stable part of the human body and are resistant to thermal, mechanical, and chemical insults. The aim of this study was to evaluate the effectiveness of mandibular intercanine distance and mesiodistal width of mandibular first molar in gender determination. Materials and Methods: The study comprised 100 participants (50 males and 50 females) in the age group of 18-23 years. The mandibular impressions were made, and casts were prepared using dental stone. The intercanine distance and mesiodistal width of the right mandibular first molar were measured using digital vernier callipers. The data obtained was statistically analysed using SPSS software version 23. Results: The mean mandibular intercanine distance was found to be 27.2 ± 2.3 in males and 25.94 ± 1.76 in females (P = 0.03). There was no statistical difference in the mesiodistal width of the mandibular molar between males and females (P = 0.166). However, the mean mesiodistal width of males was higher when compared to females. Conclusion: Males have a greater intercanine width and mesiodistal dimension when compared to females. This result will be helpful in forensic medicine, anthropology, orthodontic treatments, and clinical dentistry.

Effects of Different Test Positions on Quantitative Muscle Strength of Wrist and Finger Flexor Muscle Groups and Its Standardization.

OBJECTIVES: To explore the effects of different test positions on quantitative muscle strength of wrist and finger flexor muscle groups and to establish a standardized muscle strength test protocol for each muscle group. METHODS: Forty healthy subjects (12 males and 28 females) were recruited. A portable digital quantitative muscle strength tester, Micro FET2TM, was used to measure the flexor muscle strength of each finger and the wrist joint at the 30° extension, 0° neutral, and 30° flexion, respectively. Palmar abduction strength of the thumb was measured at 30° and 60°, respectively. Ten subjects were randomly selected from the 40 subjects, and the quantitative muscle strength of each muscle group was tested again by the same operator after an interval of 10 to 15 days. RESULTS: Except for the fact that in males, there was no significant difference in flexor muscle strength of thumb and wrist joint between 30° of wrist extension and neutral 0° position, the muscle strength of the other fingers flexion and wrist palmar flexor showed the following characteristics：30° of wrist extension > neutral 0° position > 30° of flexion, and the PAST was 30°>60°; The flexor muscle strength of all the subjects was thumb > index finger > middle finger > ring finger > little finger; All muscle strength values of male were greater than those of female, and the difference was statistically significant (P<0.05); There was no significant difference between the left and right side muscle strength values of all subjects (P>0.05). The reliability of muscle strength values measured at different times in 10 subjects was good. CONCLUSIONS: The quantitative muscle strength of each muscle group of the hand and wrist is affected by the test position, and a standardized and uniformed test position should be adopted in the actual identification. Micro FET2TM has good reliability for hand and wrist quantitative muscle strength testing. The 30° extension of the wrist can be used as the best standardized test position for the flexion muscle strength of each finger and wrist joint. The 30° position can be used as the best standardized test position for PAST.

Advancing research on femicide prevention: A mixed methods approach.

Femicide, the killing of women, girls, and infants, is a pervasive problem affecting all global societies. Policy and research are impeded by inaccurate and missing prevalence data, gaps in understanding of femicide, especially for hard-to-reach marginalized populations, and conflicting perceptions between jurisdictions. Leveraging on a combined socio-ecologic model and Public Health approach, the paper spans the methods of a computed tomography-based injury study, an in-depth media-analysis, a legislation evaluation study, and a data barriers' study. Injury patterns, media depiction, and end-user consultations will close the loop on residual problems such as implementation, data gaps, and cultural perceptions. By mixed methods research representing multiple regions, and stakeholders, this project will enhance knowledge on interpersonal, institutional, and societal factors of femicide, advancing the humanitarian forensic discipline. The research method will identify emerging trends and facilitate improvements in tertiary prevention of femicide, specific to resource settings.

The Talent Training Model of Forensic Medicine in Japan and Its Reference.

The quality of Japanese forensic experts has been widely recognized around the world, which cannot be separated from the "ripple effect" caused by the rapid rise of the modern forensic education in Japan. By continuously adopting foreign forensic education resources and teaching experience, it has finally formed a forensic professional talent training model with a clear hierarchy of basic education and professional training, as well as classroom teaching and case studies complementing each other; and it continuously improves the comprehensive quality of practitioners through domestic training and international exchange and cooperation, providing talented professionals for the development of the Japanese forensic industry. In this context, this article takes the development history of Japanese forensic medicine as the starting point to study how it gradually formed the embryonic form of forensic education in modern times. Based on this, it analyzes the characteristics of Japan's modern forensic medicine talent training model, summarizes excellent experiences for localized transformation, such as emphasizing the role of practical teaching, exerting the effectiveness of vocational skills training, and promoting international exchange and cooperation, to provide reference and inspiration for the training of relevant professional talents in China.

Avalanche fatalities in Czech Republic: a 23-years retrospective study.

Avalanche fatalities are quite rare in the Czech Republic. Due to the presence of avalanche fields in the two Czech mountains, forensic pathologists at some forensic medicine departments may encounter this specific mechanism of accidental death. The authors summarize medicolegal aspects of deaths in avalanches in the territory of the Czech Republic for the twenty-three-year period between 1993-2015. Ten avalanche fatalities were recorded during study period. The studied group consisted of nine male and one female victims. The average age of the deceased was 27.9 years. Skiers or ski-alpinists died in the avalanche in five cases (50%), climbers in two cases (20%), snowboarders in one case (10%), cross-country skiers in one case (10%) and in one case it was a fatality of child playing on a snowy hill (10%). The cause of death was suffocation in four cases (40%), blunt trauma in four cases (40%), and in the remaining two cases it was the survival of trapped persons several hours after being rescued from the avalanche in the hospital; both victims subsequently died as a result of prolonged shock (20%) due to a combination of prolonged suffocation and hypothermia. The time interval from the fall of the avalanche to the rescue of the trapped person was in the range of minutes to 3 hours. The presence of alcohol or drugs was not detected in any studied case.

Accident or abuse? Differential diagnosis of contact burns from radiators/heaters in children.

Contact burns in children are not uncommon and are often due to accidental contact. Medico-legal assessment is of paramount importance in these contexts to identify cases of abuse. In three cases of burns caused by contact with radiators or a portable heater -two accidental and one deliberate- thorough medico-legal assessment, combined with on-site event reconstruction, enabled accurate diagnoses. Accidental burns displayed a 'pattern' compatible with the incandescent instrument but were more irregular, with different depths and in different parts of the body. In contrast, intentional burns were uniform in depth, distribution and localisation, inconsistent with accidental events. In this context, the on-site inspection and direct evaluation of the objects involved were crucial in the medico-legal assessment. These are indispensable elements for a thorough analysis and abuse recognition.

Forensic Anthropology in the identification of human remains found at sea: History of two judicial cases connected by the same marine context of discovery.

Background: Calculating the immersion time at sea of human skeletal remains is a challenge for forensic investigations and the answer to this question would solve many court cases in the shortest possible time. Remains in water create profound structural changes due to countless variables that lead to difficulties in interpretation during investigations. Case report: In this paper, two forensic cases found at sea were analysed, Case A, an extensively skeletonised corpse, and Case B, an isolated, intact foot with soft tissue, both found only 9 km away from the shores of the Tyrrhenian Sea (Southern Italy). A preliminary radiodiagnostic examination was performed for both cases. Subsequently, macroscopic observation of two tattoos found on case A was carried out. Autopsy examination was then carried out with subsequent anthropometric analysis to reconstruct the biological profile of both subjects, (case A) and (case B). Finally, histological and genetic analyses were performed. Conclusions: The examinations carried out made it possible to determine two compatible biological profiles, despite the taphonomic difference, and these examinations were corroborated by the anthropometric and genetic correlation, which led to the solution of a single judicial case. In conclusion, all the investigations carried out made it possible to state that the skeletonised corpse (Case A) and the isolated foot (Case B) belonged to the same individual in life. This result made it possible to identify the victim, thus establishing the profile of an individual who had disappeared in the previous two months due to a shipwreck.

Homicide by drowning: a literature review and analysis of three cases.

Background: Homicide by drowning in adults is rare. Usually, marks of violence are found on both the victim and the perpetrator, unless the victim was under the influence of alcohol, drugs, or was unexpectedly forced or dragged into the water. Indeed, many cases of drowning in adults are believed to be accidental, but they may be the result of drunken fights or attempts to make the death appear ac-cidental. In order to define the manner of death, cooperation between the forensic pathologist and the investigators is mandatory. Indeed, the autopsy is important to distinguish homicide by drowning from other kinds of drowning. The purpose of this study is to highlight the features of homicide by drowning. Materials and Methods: Literature search was conducted using PubMed databases, using the following keywords: "(homicide) and (drowning)". 3 articles were included in the systematic review, in addition to 3 cases observed in our institute. Conclusions: Both external examination and autopsy findings and the results of the investigation are essential to differentiate a homicide by drowning from accidental ones. The low specificity and variability of external and internal findings, the possibility of atypical asphyctic and nonasphyctic pathophysiological mechanisms, whose nature is not detectable at postmortem examinations, makes the diagnosis of cause of death difficult and often based on exclusion criteria only. In complex cases only using a strict forensic method allows to use the essential tools to identify the real manner of death.

An atypical gunshot suicide: a case report and a literature overview.

Background: Gunshot suicides are more common in those people who live in countries with greater cultural accessibility of firearms and whose weapon's availability and use are easier. In the case of suicide by firearm, the most typical site of the entrance hole is represented by the temple, the forehead or the submental region, while only in a smaller percentage of cases is intra-oral. Case report: We present a particular case of suicide of an 85-year-old man, using a single-charge, short-barrelled firearm. The shot was fired on contact, with the entrance hole located at the tongue. The bullet remained held inside the body and there was no exit hole on the skin. A rigorous and multidisciplinary methodological approach was adopted, including an accurate judicial inspection of the environment, an anamnestic collection, an autoptic procedure completed by macroscopic and microscopic examination of the entrance hole and internal organs, and a radiological examination. Conclusions: In cases of gunshot suicide involving the intra-oral region, the tongue is rarely affected. Normally, the victim points the weapon upwards and the bullet follows this direction. When the entrance hole is on an atypical site, and different from the skin, and the trajectory are inusual, the interpretation of the dynamic of the event is more complex. So, it is essential to conduct a complete investigation, including the information of the forensic examination, with the data emerged in autopsy, radiological and histological examination.

A rare case of suicide by bleach fatal ingestion: a case report and a literature overview.

Background: Nowadays it is estimated that worldwide more than 700 000 people die by suicide every year and a greater amount attempt this practice. Suicide is the fourth cause of death among 15-29 years old people. Sodium Hypochlorite (NaOCl) is used in household and com-mercial bleaches and due to its easy availability, accidental exposure to or intentional ingestion of NaOCl occurs frequently. In most cases health effects are only transient but if the subject ingests a large amount of this substance, this can generate severe consequences as oesophageal or stomach lesions and electrolytic imbalance. In the present study we analyse a rare case of suicide by fatal ingestion of bleach. Case Report: Case of a caucasic 47 years old woman with a background of several suicide attempts by exogenous substance ingestion that was found death alone in her apartment. The purpose of our investigation was identifying the cause of death. A rigorous and multidisciplinary methodological approach was adopted, including an accurate judicial inspection of the environment, an anamnestic collection, an autoptic procedure completed by macro and microscopic examinations of internal organs and a toxicological examination of biological fluids. Furthermore, a literature overview of similar cases was carried out. The resulting evidence demonstrates that woman's death occurred after a massive bleach ingestion. Conclusions: This case report highlights the importance of forensic methodology in investigating the ingestion of exogenous substances. Crime scene investigation, a detailed post-mortem examination, toxicology and a complete histopathological study are mandatory to solve the enigma.

A Three-Year Investigation on Corpses Referred to Legal Medicine Organization from An Iranian General Hospital: A Cross-Sectional Study.

Background: A Medical Certificate of Cause of Death (MCCD) is a legal and enforceable document issued by the attending physician. However, according to the instructions, in many cases such as sudden, unexplained, and extraordinary deaths, along with some uncommon causes, such as cases suspicious of murder, the deceased patient must be referred to the Iranian Legal Medicine Organization (ILMO). Moreover, the unnecessary referral of corpses to ILMO can increase the workload of the staff, finally confronting the family of the deceased with high emotional and financial costs. Methods: In this cross-sectional study, the medical records of all deceased patients referred from Hazrat Rasool Hospital to the ILMO (565 cases) in a three-year period from April 2016 to March 2019 were investigated and analyzed using SPSS22 software with chi-squared and T-test. Results: Among all the patients who passed away during this time (4,239 patients), 565 were referred to ILMO, accounting for 13.3% of deaths. The most common causes of referral were car and motorcycle accidents, with a total prevalence of 27.1%, dead-on-arrival (DOA) prevalence of 21.3%, and death with an unknown cause prevalence of 15.3%. Significant correlation was also detected between causes of referral with gender, time of death, and age. For example, Car accidents and lawsuits against medical staff were more common in men and women, respectively. Conclusion: Car and motorcycle accidents, DOA, and unknown causes were the most prevalent causes of referral in this study. In general, few studies have been conducted regarding the causes of referral of the deceased to the Legal Medicine Organization. In this study, we collected relevant variables to investigate this issue thoroughly.

Reviewing hereditary connective tissue disorders: Proposals of harmonic medicolegal assessments.

Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of inherited diseases. These disorders show genetic mutations with loss of function of primary components of connective tissue, such as collagen and elastic fibers. There are more than 200 conditions that involve hereditary connective tissue disorders, while the most known are Marfan syndrome, Osteogenesis Imperfecta, and Ehlers-Danlos syndromes. These disorders need continuous updates, multidisciplinary skills, and specific methodologic evaluations sharing many medicolegal issues. Marfan syndrome and Ehlers-Danlos syndromes show a high risk of early sudden death. As a consequence of this, postmortem genetic testing can identify novel genotype-phenotype correlations which help the clinicians to assess personalized cardiovascular screening programs among the ill subjects. Genetic testing is also essential to identify children suffering from Osteogenesis Imperfecta, especially when a physical abuse is clinically suspected. However, this is a well-known clinical problem even though there are still challenges to interpret genetic data and variants of unknown significance due to the current extensive use of new genetic/genomic techniques. Additionally, the more significant applications and complexities of genomic testing raise novel responsibilities on the clinicians, geneticists, and forensic practitioners as well, increasing potential liability and medical malpractice claims. This systematic review provides a detailed overview on how multidisciplinary skills belonging to clinicians, medicolegal consultants, radiologists, and geneticists can cooperate to manage HCTDs from autopsy or clinical findings to genetic testing. Thus, technical aspects need to be addressed to the medicolegal community since there is no consensus works or guidelines which specifically discuss these issues.

Inequality in Forensic Medicine in India: The Current Scenario and Way Forward.

Background Forensic Medicine (FM) is one of the core specialties of medicine in India, which serves as a bridge between medical science and India's justice delivery systems. Although FM experts play a crucial role in handling medicolegal cases, there is an increasing deficit of FM experts in India. This may be due to the inadequate postgraduate (PG) seats across the states and the low uptake of PG seats in FM. This study was conducted to explore the current status of PG seats along with the Forensic Medicine Toxicology (FMT)/FM index across Indian states. Methodology In this cross-sectional study, data on the number of PGs in FMT/FM and the institutes offering PG courses in FMT/FM were searched on the official website of the National Medical Commission. The data available on the website until November 2023 were incorporated. The FMT/FM index was calculated at the national and state levels, and the states were graded based on the national FMT/FM index. Results The national FMT/FM PG trainee index was 0.054. Considering this as the reference value, grading of the FMT/FM PG trainee index was done as the highest (1.159 to 0.308), higher than the nation (0.054 but less than 0.308), lower than the nation (0.054 but higher than 0.00), and zero. Among all the states and union territories, Andaman & Nicobar, Arunachal Pradesh, Dadra and Nagar Haveli, Jammu & Kashmir, Lakshadweep, Mizoram, Nagaland, Sikkim, and Ladakh had zero FMT/FM PG index due to non-availability of any PG seats for FMT/FM. In total, 20 states had an FMT/FM PG index higher than India's FMT/FM PG index headed by Pondicherry (1.159), followed by Chandigarh (0.429) and Goa (0.308). Conclusions PG seats were highly deficient in several states, which is more likely to affect justice delivery in the future across these states. This study has a few limitations, as we did not explore the actual intake of these PG seats across different states. We anticipate a lower intake of PG seats due to factors such as low demand, fewer job opportunities, and monetary gain. However, this needs further exploration in future studies.

Changes in the microbial community of semen exposed to different simulated forensic situations.

Semen is one of the common body fluids in sexual crime cases. The current methods of semen identification have certain limitations, so it is necessary to search for other methods. In addition, there are few reports of microbiome changes in body fluids under simulated crime scenes. It is essential to further reveal the changes in semen microbiomes after exposure to various simulated crime scenes. Semen samples from eight volunteers were exposed in closed plastic bags, soil, indoor, cotton, polyester, and wool fabrics. A total of 68 samples (before and after exposure) were collected, detected by 16S rDNA sequencing, and analyzed for the microbiome signature. Finally, a random forest model was constructed for body fluid identification. After exposure, the relative abundance of Pseudomonas and Rhodococcus changed dramatically in almost all groups. In addition, the treatment with the closed plastic bags or soil groups had a greater impact on the semen microbiome. According to the Shannon indices, the alpha diversity of the closed plastic bags and soil groups was much lower than that of the other groups. Attention should be given to the above two scenes in practical work of forensic medicine. In this study, the accuracy of semen recognition was 100%. The exposed semen can still be correctly identified as semen based on its microbiota characteristics. In summary, semen microbiomes exposed to simulated crime scenes still have good application potential for body fluid identification. IMPORTANCE: In this study, the microbiome changes of semen exposed to different environments were observed, and the exposed semen microbiome still has a good application potential in body fluid identification.

Firearm ownership and suicide: Has the time come to discuss uniformity of health and social assessments in aid of regulation? Reflection from a retrospective study on a forensic case series.

Background: Firearm-related deaths are an issue of ongoing public interest, from a health and economic perspective. Worldwide, firearm prevalence in suicides varies widely, depending on multiple factors including the availability of weapons in each country. Although several studies have shown that national laws about gun ownership, reducing legal access to guns, decrease the risk of suicide by firearm, the current situation clashes with widely differing legislations. Study design: Retrospective study on a forensic case series. Methods: Autopsy reports assessed at the Section of Legal Medicine of Milan (Italy) from January 2014 to December 2023 were retrospectively documented. Only firearm suicides were considered. For each case, a close analysis of the criminal offence reports has been performed to obtain information about the gender and age of the victim, as well as the legal possession of firearms, psychiatric disorders, alcohol, and illicit drug abuse. Results: Among all the 1,164 suicides assessed at the Section of Legal Medicine of Milan over a 10-year-period, 101 cases (8.7%) were firearm-related. The male to female ratio was therefore about 13:1. No seasonal trends were observed. Most of the individuals owned the firearm license. Of the entire dataset, 35.6% suffered from psychiatric disorders, 4% of alcohol abuse and 2% of drug addiction. Among the owners of a firearm license, 42.3% had psychiatric disorders. Conclusions: Knowledge about firearm suicide and its relation to firearm legal possession is limited and current preventive laws should be reconsidered. Present administrative and clinical examinations required to obtain a firearm license in Italy and in some European territories are dealt with. The evaluation of the firearm-related risk of abuse is an essential but complex procedure, which requires not only clinic-anamnestic data but also in-deep psychiatric information. There is a need to develop and reinvigorate a debate that currently presents very heterogeneous solutions, but which would probably benefit from a common vision of the prevention strategies that can be implemented and enacted for the benefit of the entire community.

Gender Gap in academic medicine: a narrative review and the Italian forensic context.

Background: Gender gap is a neologism that identifies the disparity between social and professional conditions experienced by females compared to males. The disparity increases as one ascends the academic hierarchy. In recent years, the debate has expanded, and more options have been planned for the elimination of the current gender gap. Methods: This research was conducted by examining the landscape of the gender gap, particularly in the academic forensic medicine field. Our analysis involved reviewing papers published between 2006 and 2024, identified through electronic database searches (PubMed). The search terms used were: "gender gap" AND "academic" AND "medicine" AND "leadership." In total, we analyzed 85 papers. Additionally, we examined data from forensic medicine residency programs. Conclusions: The representation of women in medicine is well-known. Despite the increasing number of women in leadership positions in medicine, they still lag significantly behind men. These data highlight a situation that could be seen as grounds for an accusation of "academic abuse". In the Italian forensic residency programs, less than 20% are led by women, and among these, not all hold the rank of full professor. Although a certain rebalancing is already underway, the gap is still significant. There are already regulations obliging local authorities to promote gender equality in councils, companies, and institutions under their jurisdiction. It would be desirable to consider minimum quotas for female participation in university competitions. This would be a first step toward eliminating the gender gap in academic and forensic medical fields.

Characteristics of indoor and outdoor fatal hypothermia cases in Chiba, Japan.

In forensic medicine, hypothermia is a frequently encountered cause of death, and this characteristic provides public health information to prevent similar deaths in the future. Previous studies revealed regional differences in hypothermia occurrence (indoors or outdoors). However, to our knowledge, no recent studies in Japan have directly compared the characteristics of indoor- and outdoor-onset cases based on forensic autopsy reports. Hence, this study aimed to determine the characteristics and risks of unexpected hypothermia-related death. It included 218 cases from the Chiba Prefecture, Japan, wherein forensic autopsies were performed and hypothermia was diagnosed; these cases were categorized into indoor- and outdoor-onset cases, and their characteristics were examined. The results showed no significant differences between the two groups in relation to the age of onset or residential environment (i.e., the presence or absence of cohabitants). The outdoor-onset group tended to have a higher incidence of dementia. Regarding the causes of hypothermia, the indoor group had more internal causes (p < 0.0001), whereas the outdoor group had more primary and external causes (p < 0.0001 and p = 0.0029, respectively). The indoor group was more undressed than the outdoor group. Atypical antipsychotic components were predominantly detected in the blood in the outdoor group (p = 0.0077). The body mass index tended to be lower in the indoor group than in the outdoor group. Broadening public awareness of the present study findings may aid in developing preventative strategies for hypothermia based on the location of onset.

Loss of chance: the uncertainty of the event or the uncertainty of the conduct? Case Series and Medicolegal Considerations.

Background: The concept of damages for loss of chance originated in France in 1877 and was adapted to healthcare in 1962. In Italy, it was first introduced in healthcare liability in 2004, with Civil Court of Cassation decision No. 4400. Italian jurisprudence recognizes the loss of chance as an independent, legally and economically assessable damage, distinct from the actual outcome lost. The landmark St. Martin Judgments of 2019 further established that such damages can be claimed if they involve appreciable, serious, and consistent values. This requires proving a causal link between the conduct and the lost chance, based on established civil law criteria. Case report: 1) a 71-year-old man whose lung carcinoma was not diagnosed in time, leading to a significant reduction in survival chances. 2) a woman whose breast cancer diagnosis was delayed, resulting in a more advanced stage and decreased survival prospects. Discussion: In medical professional liability, the Supreme Court requires a high probability or certainty of causation for recognizing the causal link between wrongful conduct and damage. The assessment involves proving both the causal link and the reasonable probability of a lost opportunity's realization. Hypothetical damage is insufficient for compensation. Conclusions: The compensability of loss of chance relies on proving the causal link between the negligent act and the uncertain event, where the impact on the patient's non-pecuniary sphere is significant. Medicolegal practice faces challenges in distinguishing between causality and damage, which can lead to confusion between biological damage and damage from loss of opportunity.